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/f � � S' ,�� �- , �' � <br /> D8f9�1_� v�mm wo.w.v.,mn. �_T— Bc_ <br /> Appllcatlon For eiav uno� • S S <br /> � <br /> PUBLIC WORKS PERMIT P�°i„�;;�� . <br /> Leu�ppl FeaPua i <br /> PrintorTypeOnly 8.�.�=.o�. s_,J�� <br /> �59 `1�- <br /> ���� �-- ��7F'i�'t"k;.�IJ� I� ?��s��C' 1���� ► )t«<-n�. �l,'�Ir'( T 'jK��C.'/ 1��./S'h h- <br /> Owner MaIIIngAdd�eas Cily Zip Phone <br /> �CJA�"Sii)i) ���tit��C'G�CTII�ti- .1`��'L� �� ��� ' << I- Jr �i'�l ( �i�Y�C''J �� 7 f.. ��� S` �� <br /> Applleenl Meiling Addrees Cily 2ip Phone <br /> //{'� � /� c ` q/ I_ <br /> DBecribe Proposed Work L--��-� S I �� �<< � �(�l r f. �-- �C/l ] I�n�(` � �//h Li/(,��( ��L— <br /> P�o�ect Addreas pf known� _—/G 7 — ��� ZN cC. � I <br /> Pitech laur(4) coples ol plane lor p�oposed work� Draw lo acele and note Ihe lollowing es applicable � <br /> • Property Llnen • Centerhne al slreet � �, <br /> • Ou�line and dimenslona ol a�l erlstinP and • Indicete North <br /> proposed atructures on fhe lol • Show any proposed graAing chnnges <br /> • E►Ieting and propoeeA utlllties • Show measuremen;s • � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMII�CONDITIONS <br /> 1. All celle for inspectlon shell be made 24 his. in advence� phone 259•8B1 5 � <br /> 2. All work ahefl be performad in eccortlence with Ihis permlt untl current Ci1y ol Eve�ell Design end Construcl�on <br /> Stenderda end Specilicefiona. <br /> 3. Call Location Underground Service 48 h�a belore you diB. TOLL FHEE NUMBER 1•800•424•5555. � <br /> s! A �° " <br /> c�'' c. ��oE — 2 T.c�.�.r AS�...� c % D,�'�a t «-�y/ O <br /> H�i�[ �E J�.t'��l'icJFp �'f/ TNE A/�VliCil�.�? `£��t A!-r �SS <br /> C�f �� 7� A✓E. S,E. �C� Ti/E CXiSTi.dE' B['i[ D�q. r- � <br /> /�/PA'TH �l� TNE I'h'G'�OSF',d �Uili�..tii�., APv�.��a.c�% � <br /> b��i�c Acsc, Pes r•. O f J /�q�'li�C�(- Sr'4<" E S .4T T.v� <br /> E,r:s rii✓cr dc v<c).�vG Ty,a r Ai'r Asr�il.a c � A�G�c� .Sar,/'cD. O <br /> ..,�r' /��'c�1ElT T�+ h'F l'r.c's�,c c�c:E'.� f'E.t' <l f'�'�� -E� /�'ca.c_; li <br />' D.e�EO ,.3�.:t7�.4s � ,� <br /> � �,j/�/ �� �A„_,n,�(�.(/�'�'✓�"� ����ACKN DF� ENT�$�}NDITIONS <br /> --� v�• ..�� �" rll �� v <br /> The undersigned owne ,app ca 1 hereby egrees lo hold and save ha�m� <br /> less the Cdy ol Everelt Irom any entl all clelms lo� damages, cosls <br /> QMp2f1S98. OI f,eU52S OI BC�1OA �h8� may a�ise 6ecause ol 108�811H�1on <br /> c�(! L� /� / y� �,J ,�J and mainlenance ol Ihe Impwvement or other right�ol�way use herr�b� <br /> //[L.O !f7lbl�- npplied lor nnd lur�her agrees lo remove seme upon notice Irom Ih�� <br /> App�oved�or Conslruc�ion Dete <br /> Ciry antl b replace public property damagetl thereby <br /> �CYI�STj�LlC76��J �- �L�c�% �c G � � � — <br /> FINAI INSPECTION � De�e •' ��� �- � ' ���1�_ !_'� ��!-� ��� �'�� <br /> Approved as Constructed ���%� ��70.JJ Signalure ol Appl ant Date <br /> �5�Uc�S'TZ�'—.i� yyORK AUTHOHIZED BV Thi15 PERMIT MUST BE STARTED WITHIN <br /> everett �'UBLiC WORKS DEP TMFNT • �80 DAVS OF DATE PERMIT IS ISSUED AND THEHEAF7ER IS TO <br /> � 3200 Cedar Slreet ��G'I ��C7'C'1L�1� � � "�'' BE DIUGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Everelt, WA 88201 �—��-� \ CANCELLED BY THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone: 259�BB15 �� �t� Y PROJECT OYER 90 DAVS DURATiON. <br />